This document discusses tools for evaluating functional outcomes and physical impairment in orthopedic trauma patients. It defines key terms like disability, impairment, and handicap. It outlines the physician's role in impairment evaluation and providing information to third-party payers. Common impairment scales like the AMA Guide and AAOS Manual are described. The importance of assessing both objective clinical outcomes and subjective patient-reported functional outcomes is emphasized.
Post Stroke Upper Extremity Rehabilitation - A Clinical PerspectivePhinoj K Abraham
Guest Speak at 3rd Annual national conference of Indian Federation of Neurorehabilitation (IFNRCON 2015) at Mumbai by Phinoj K. Abraham, Neuro Occupational Therapy on "Post Stroke Upper Extremity rehabilitation - A Clinical Perspective"
For Video: http://youtu.be/uCnwdzLtPSQ
This PPT is prepared for the basic understanding of third year physiotherapy students in the field of ICF. It describes the reasons for use of ICF, basic terminology and its meanings, relationship between different domains of ICF with relevant clinical examples.
Matt Lewis Law Dallas Texas - ODG - July 11, 2008Matt Lewis Law
ODG: Medical Treatment For Back And Neck Injuries - 2008
Rule 137.100 Treatment Guidelines
HCP’s shall provide treatment in accordance with the current edition of the Official Disability Guidelines – Treatment in Workers’ Comp unless the treatment requires preauthorization under Rule 134.600
Services provided in accordance with the Guidelines is presumed reasonable and reasonably required (medically necessary).
A biopsychosocial approach to stroke physiotherapy. This is a move to integrate the personal and environmental factors to the standing biomedical understanding of the disease for a tailor-made treatment.
Thinking About Success and Failure in Obesity CareObesityHelp
Even though obesity has officially been classified as disease by important groups like the American Medical Association, many people – doctors included – put all the emphasis on the scale and on other measures like body mass index (BMI). In this talk we will look at how success is measured now and other ways to define success after bariatric surgery. Time allowing, we will also talk about some of the long-term issues related to health and nutrition after bariatric surgery, with a focus on things that contribute to weight regain.
Post Stroke Upper Extremity Rehabilitation - A Clinical PerspectivePhinoj K Abraham
Guest Speak at 3rd Annual national conference of Indian Federation of Neurorehabilitation (IFNRCON 2015) at Mumbai by Phinoj K. Abraham, Neuro Occupational Therapy on "Post Stroke Upper Extremity rehabilitation - A Clinical Perspective"
For Video: http://youtu.be/uCnwdzLtPSQ
This PPT is prepared for the basic understanding of third year physiotherapy students in the field of ICF. It describes the reasons for use of ICF, basic terminology and its meanings, relationship between different domains of ICF with relevant clinical examples.
Matt Lewis Law Dallas Texas - ODG - July 11, 2008Matt Lewis Law
ODG: Medical Treatment For Back And Neck Injuries - 2008
Rule 137.100 Treatment Guidelines
HCP’s shall provide treatment in accordance with the current edition of the Official Disability Guidelines – Treatment in Workers’ Comp unless the treatment requires preauthorization under Rule 134.600
Services provided in accordance with the Guidelines is presumed reasonable and reasonably required (medically necessary).
A biopsychosocial approach to stroke physiotherapy. This is a move to integrate the personal and environmental factors to the standing biomedical understanding of the disease for a tailor-made treatment.
Thinking About Success and Failure in Obesity CareObesityHelp
Even though obesity has officially been classified as disease by important groups like the American Medical Association, many people – doctors included – put all the emphasis on the scale and on other measures like body mass index (BMI). In this talk we will look at how success is measured now and other ways to define success after bariatric surgery. Time allowing, we will also talk about some of the long-term issues related to health and nutrition after bariatric surgery, with a focus on things that contribute to weight regain.
"Discover the comfort and convenience of home physiotherapy, where healing comes to your doorstep. Our dedicated team of experienced physiotherapists brings expert care right to your home, ensuring you receive personalized, one-on-one attention in an environment that's familiar and comfortable. Whether you're recovering from an injury, managing a chronic condition, or seeking to improve your mobility, our home physiotherapy services are tailored to your unique needs. Say goodbye to the hassle of
The Education HR in the North West Conference, January 2018 - Capability and ...Browne Jacobson LLP
This session looks at the definition of disability and the risks associated with this, as well as the role of occupational health and capability dismissals.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
3. Definitions
• Disability
– assessed by non medical means
– represents an alteration of an individual’s
capacity to meet personal, social, or
occupational demands or to meet
statutory or regulatory requirements.
6. Your Role as Physician
• Identify objective findings
• Sole responsibility of the physician to
determine permanent impairment
• Most impairment is caused by
musculoskeletal injuries
7. Role as Physician
• Care not finished when fractures healed and
rehabilitation finished
• Must participate in the impairment
evaluation process
• Many state/federal laws limit how a
physician assigns ratings
8. Third-Party Payers
• Often request impairment evaluations
– Use this information to determine settlement of
claims
• Examples: state workman’s compensation
boards, private insurance companies, Social
Security and Veterans Administration
– Each has their own rules and regulations
9. Third- Party Payers
• Will ask specific questions about permanent
impairment
• Physicians usually send letters directly to
these payers to provide updates
10. Work Restrictions
• Another role of the physician is to estimate
how much and what level of work or
activity a patient can safely tolerate
• The physician assigns impairment and work
restrictions but it is the third-party payers’
and the patient’s responsibility to find the
appropriate job
11. Work Restrictions
• Most commonly used guidelines are those of
the Social Security Administration:
• Consist of differing levels of physical activity
– Very heavy
– Heavy
– Medium
– Light
– Sedentary
12. Work Restrictions
• Very heavy work is that which involves lifting
objects weighing more than 100 lb at a time, with
frequent lifting or carrying of objects weighing 50
lb or more
• Heavy work involves the lifting of no more than
100 lb at a time, with frequent lifting or carrying
of objects weighing up to 50 lb.
• Medium work involves the lifting of no more than
50 lb at a time, with frequent lifting or carrying of
objects weighing up to 25 lb
13. Work Restrictions
• Light work involves lifting no more than 25 lb at a
time, with frequent lifting or carrying of objects
weighing up to 10 lb.
• Sedentary work involves the lifting of no more
than 10 lb at a time and occasional lifting or
carrying of small items.
14. Work Restrictions
• Work restrictions should be placed at a
level that does not compromise healing or
cause too much discomfort during the
recovery phase of injury
• Once maximum medical improvement has
been reached if patient is unable to return to
previous job then permanent restrictions
should be set.
15. Modern Impairment Scales
• Most widely used:
• AMA’s Guide to the Evaluation of
Permanent Impairment
• AAOS’s Manual for Orthopedic Surgeons
in Evaluating Permanent Physical
Impairment
16. AMA’s Guide
• “Whole man” concept
• Each part of body assigned a percentage of
its contribution to the whole
• Loss of function of an extremity is
expressed as percentage of the value of the
whole extremity, then the impairment of the
whole man is calculated from this.
17. AMA’s Guide
• Lower extremity is 40% of whole man
• Upper extremity is 60%
• Other than amputation the ratings are based
solely on the residual range of motion and
does not consider factors like pain, limb
shortening, or weakness
18. AAOS’ Manual
• This considers loss of motion like the
AMA’s guide but also takes into account
pain separately
• Four grades of pain: Mild to severe
19. AAOS’s Manual
• Mild pain (Grade I) – does not contribute to
impairment
• Moderate pain (Grade II) – might require
treatment and does contribute to a minor degree to
impairment
• Severe pain (Grade III) – pathological changes
and clinical findings indicate that pain is
contributing significantly to impairment
• Very severe pain (Grade IV) – physical
impairment is nearly complete secondary to pain
21. Temporary Total Disability
• Starts at time of injury
• Lasts until patient achieves a reasonable
degree of mobility and independence, can
perform ADL’s reasonably
• Patient must be off narcotics
• Must be evaluated by physician periodically
to document/update progress
22. Temporary Partial Disability
• Starts at the end of temporary total
disability
• Lasts until patient back to normal function
or a permanent impairment is assigned
• May return to work with restrictions
• Must be reevaluated by physician
23. Fractures and Associated
Impairments
• Increased impairment may be assigned
based on the following:
1) Handiness (dominant vs nondominant
upper extremity injury)
2) Nonunion
3) Limb length discrepancy
4) Malunion
25. Functional Outcomes
• Traditional orthopedic evaluations in the
past have focused on impairment measures
• These include findings like range of motion,
muscle strength, and radiographic healing
• These findings have the advantage of being
easy to measure
27. Functional Outcomes
• The focus of outcomes assessment has now
shifted to patient-based subjective
assessments of outcome
• A combination of impairment and patient-
based assessment is probably the ideal
measure of outcome
• Patient satisfactions is very important!
28. Functional Outcomes
• Up until recently the focus of most
orthopedic literature has been based on
clinical outcomes
• Ultimate outcome however, should be a
combination of clinical, functional, health-
related outcomes, and satisfaction with care.
29. Functional Outcomes
• Clinical outcomes are what we are used to
(range of motion, union, etc.)
• Functional outcomes are total patient
outcome, not just the injured part. Include:
– mental health
– social function
– role function,
– physical function
– ADL’s
31. Clinical Outcomes in Trauma
• The trauma registry is the main source of
collected data at most institutions.
• The American College of Surgeons
Committee on Trauma has made
recommendations on what data should be
collected and evaluated
32. Clinical Outcomes in Trauma
• One of the key components is measure of
ISS (Injury Severity Score)
– Not a good measure for most orthopedic
injuries
• OTA has developed their own software to
track orthopedic injuries more completely
• Extensive resources required for appropriate
data collection
33. Clinical Outcomes in Trauma
• Unrealistic to collect functional outcome
data on all trauma patients
• Multicenter studies are the wave of the
future for outcomes research
34. Health-Related Quality-of-Life
Instruments in Common Use for
Musculoskeletal Problems
• Medical Outcomes Study Short Form 36
(SF-36)
• Sickness Impact Profile (SIP)
• Western Ontario and McMaster University
Osteoarthritis Index (WOMAC)
• Nottingham Health Profile
36. Summary
• Our goal should be to fairly identify our
patient’s impairments, assist in disability
evaluation, and begin assessing patient’s
outcomes based on their perceptions as well
as our objective findings